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Bitsadze V, Lazarchuk A, Vorobev A, Khizroeva J, Tretyakova M, Makatsariya N, Gashimova N, Grigoreva K, Tatarintseva A, Karpova A, Mostovoi A, Zainulina M, Kapanadze D, Blbulyan A, Kuneshko N, Gris JC, Elalamy I, Gerotziafas G, Makatsariya A. Systemic Inflammatory Response Syndrome, Thromboinflammation, and Septic Shock in Fetuses and Neonates. Int J Mol Sci 2025; 26:3259. [PMID: 40244141 PMCID: PMC11989690 DOI: 10.3390/ijms26073259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/24/2025] [Accepted: 03/28/2025] [Indexed: 04/18/2025] Open
Abstract
This article explores systemic inflammatory response syndrome (SIRS), thromboinflammation, and septic shock in fetuses and neonates, offering a comprehensive examination of their pathophysiology, diagnostic criteria, and clinical implications. It identifies SIRS as an exaggerated response to external stress, disrupting the balance between inflammation and adaptive mechanisms, driven by cytokines such as TNF-α and IL-1. The fetal inflammatory response syndrome (FIRS), a subset of SIRS, is noted for its role in adverse neonatal outcomes, including organ damage, inflammation, and long-term developmental disorders. The article discusses the extensive effects of FIRS on critical systems, including the blood, lungs, central nervous system, and kidneys. It highlights the challenges in diagnosing and managing septic shock in neonates, focusing on the relationship between inflammation and the hemostatic system. Additionally, the paper points out recent advancements, such as the convergent model of coagulation and emerging biomarkers like microRNAs for early detection. Despite this progress, gaps remain in understanding the molecular mechanisms underlying these conditions and in developing effective therapeutic strategies. This highlights the necessity for targeted research to mitigate the morbidity and mortality associated with septic shock in neonates.
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Affiliation(s)
- Victoria Bitsadze
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Arina Lazarchuk
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Alexander Vorobev
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Jamilya Khizroeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Maria Tretyakova
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Natalia Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Nilufar Gashimova
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Kristina Grigoreva
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Alena Tatarintseva
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
| | - Anna Karpova
- Vorokhobov City Clinical Hospital No 67, Moscow Healthcare Department, 2/44 Salyama Adilya Str., Moscow 123423, Russia; (A.K.); (A.M.)
- Russian Medical Academy of Continuous Professional Education, Health Ministry of Russian Federation, 2/1 bldg. 1, Barrikadnaya Str., Moscow 123993, Russia
- Department of Polyclinic Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry of Institute of Postgraduate Education of Yaroslavl State Medical University, Yaroslavl State Medical University, Health Ministry of Russian Federation, 5 Revolutsionnaya Str., Yaroslavl 150000, Russia
| | - Aleksei Mostovoi
- Vorokhobov City Clinical Hospital No 67, Moscow Healthcare Department, 2/44 Salyama Adilya Str., Moscow 123423, Russia; (A.K.); (A.M.)
- Russian Medical Academy of Continuous Professional Education, Health Ministry of Russian Federation, 2/1 bldg. 1, Barrikadnaya Str., Moscow 123993, Russia
- Department of Polyclinic Therapy, Clinical Laboratory Diagnostics and Medical Biochemistry of Institute of Postgraduate Education of Yaroslavl State Medical University, Yaroslavl State Medical University, Health Ministry of Russian Federation, 5 Revolutsionnaya Str., Yaroslavl 150000, Russia
| | - Marina Zainulina
- Snegirev Maternity Hospital No 6, 5 Mayakovskogo Str., Saint Petersburg 192014, Russia;
- Department of Obstetrics, Gynecology and Reproductology of Pavlov First Saint Petersburg State Medical University, Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation, 6/8 Lev Tolstoy Str., Saint Petersburg 197022, Russia
| | - Daredzhan Kapanadze
- Center of Pathology of Pregnancy and Hemostasis «Medlabi», 340112 Tbilisi, Georgia;
| | - Armen Blbulyan
- Research Center of Maternal and Child Health Protection, 22 Mashtots Avenue, Yerevan 0002, Armenia;
| | - Nart Kuneshko
- Moscow’s Region Odintsovo Maternity Hospital, Odintsovo 143003, Russia;
| | - Jean-Christophe Gris
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
- Faculty of Pharmaceutical and Biological Sciences, Montpellier University, 34093 Montpellier, France
| | - Ismail Elalamy
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
- Faculté Privee de Médecine de Marrakech (FPMM), Route Amizmiz, Marrakech 42312, Morocco
- Hopital Americain de Paris, 55 rue du Château, Neuilly Sur Seine, 92200 Paris, France
| | - Grigoris Gerotziafas
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
- INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team “Cancer Biology and Therapeutics”, Group “Cancer—Angiogenesis—Thrombosis”, University Institute of Cancerology (UIC), Sorbonne University, 34 Rue du Crozatier, 75012 Paris, France
- Thrombosis Center, Tenon—Saint Antoine University Hospital, Hôpitaux Universitaires Est Parisien, Assitance Publique Hôpitaix de Paris (AP-HP), 4 Rue de la Chine, 75020 Paris, France
| | - Alexander Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, The I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str 8-2, Moscow 119435, Russia; (V.B.); (A.L.); (A.V.); (M.T.); (N.M.); (N.G.); (K.G.); (A.T.); (J.-C.G.); (I.E.); (G.G.); (A.M.)
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Bahaaeldin M, Bülte C, Luelsberg F, Kumar S, Kappler J, Völker C, Schilling K, Baader SL. Engrailed-2 and inflammation convergently and independently impinge on cerebellar Purkinje cell differentiation. J Neuroinflammation 2024; 21:306. [PMID: 39609827 PMCID: PMC11603920 DOI: 10.1186/s12974-024-03301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 11/17/2024] [Indexed: 11/30/2024] Open
Abstract
Autism spectrum disorders (ASD) have a complex pathogenesis thought to include both genetic and extrinsic factors. Among the latter, inflammation of the developing brain has recently gained growing attention. However, how genetic predisposition and inflammation might converge to precipitate autistic behavior remains elusive. Cerebellar structure and function are well known to be affected in autism. We therefore used cerebellar slice cultures to probe whether inflammatory stimulation and (over)expression of the autism susceptibility gene Engrailed-2 interact in shaping differentiation of Purkinje cells, key organizers of cerebellar histogenesis and function. We show that lipopolysaccharide treatment reduces Purkinje cell dendritogenesis and that this effect is enhanced by over-expression of Engrailed-2 in these cells. The effects of lipopolysaccharide can be blocked by inhibiting microglia proliferation and also by blocking tumor necrosis factor alpha receptor signaling, suggesting microglia and tumor necrosis factor alpha are major players in this scenario. These findings identify Purkinje cells as a potential integrator of genetic and environmental signals that lead to an autism-associated morphology.
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Affiliation(s)
- Mohammed Bahaaeldin
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany
| | - Carolin Bülte
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany
| | - Fabienne Luelsberg
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany
| | - Sujeet Kumar
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany
- National Reference Laboratory for Tuberculosis, ICMR-RMRC, Bhubaneswar, Odisha, India
| | - Joachim Kappler
- Institute of Biochemistry and Molecular Biology, University of Bonn, Nussallee 11, 53125, Bonn, Germany
| | - Christof Völker
- Institute of Biochemistry and Molecular Biology, University of Bonn, Nussallee 11, 53125, Bonn, Germany
| | - Karl Schilling
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany
| | - Stephan L Baader
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53125, Bonn, Germany.
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Suleri A, Creasey N, Walton E, Muetzel R, Felix JF, Duijts L, Bergink V, Cecil CAM. Mapping prenatal predictors and neurobehavioral outcomes of an epigenetic marker of neonatal inflammation - A longitudinal population-based study. Brain Behav Immun 2024; 122:483-496. [PMID: 39209009 PMCID: PMC11784988 DOI: 10.1016/j.bbi.2024.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/19/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND DNA methylation levels at specific sites can be used to proxy C-reactive protein (CRP) levels, providing a potentially more stable and accurate indicator of sustained inflammation and associated health risk. However, its use has been primarily limited to adults or preterm infants, and little is known about determinants for - or offspring outcomes of - elevated levels of this epigenetic proxy in cord blood. The aim of this study was to comprehensively map prenatal predictors and long-term neurobehavioral outcomes of neonatal inflammation, as assessed with an epigenetic proxy of inflammation in cord blood, in the general pediatric population. METHODS Our study was embedded in the prospective population-based Generation R Study (n = 2,394). We created a methylation profile score of CRP (MPS-CRP) in cord blood as a marker of neonatal inflammation and validated it against serum CRP levels in mothers during pregnancy, as well as offspring at birth and in childhood. We then examined (i) which factors (previously associated with sustained inflammation) explain variability in MPS-CRP at birth, including a wide range of prenatal lifestyle and clinical conditions, pro-inflammatory exposures, as well as child genetic liability to elevated CRP levels; and (ii) whether MPS-CRP at birth associates with child neurobehavioral outcomes, including global structural MRI and DTI measures (child mean age 10 and 14 years) as well as psychiatric symptoms over time (Child Behavioral Checklist, at mean age 1.5, 3, 6, 10 and 14 years). RESULTS MPS-CRP at birth was validated with serum CRP in cord blood (cut-off > 1 mg/L) (AUC = 0.72). Prenatal lifestyle pro-inflammatory factors explained a small part (i.e., < 5%) of the variance in the MPS-CRP at birth. No other prenatal predictor or the polygenic score of CRP in the child explained significant variance in the MPS-CRP at birth. The MPS-CRP at birth prospectively associated with a reduction in global fractional anisotropy over time on mainly a nominal threshold (β = -0.014, SE = 0.007, p = 0.032), as well as showing nominal associations with structural differences (amygdala [(β = 0.016, SE = 0.006, p = 0.010], cerebellum [(β = -0.007, SE = 0.003, p = 0.036]). However, no associations with child psychiatric symptoms were observed. CONCLUSION Prenatal exposure to lifestyle-related pro-inflammatory factors was the only prenatal predictor that accounted for some of the individual variability in MPS-CRP levels at birth. Further, while the MPS-CRP prospectively associated with white matter alterations over time, no associations were observed at the behavioral level. Thus, the relevance and potential utility of using epigenetic data as a marker of neonatal inflammation in the general population remain unclear. In the future, the use of epigenetic proxies for a wider range of immune markers may lend further insights into the relationship between neonatal inflammation and adverse neurodevelopment within the general pediatric population.
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Affiliation(s)
- Anna Suleri
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole Creasey
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Esther Walton
- Department of Psychology, University of Bath, Bath, UK
| | - Ryan Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Biomedical Data Sciences, Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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Euclydes V, Braga CI, Gouveia G, Martinez RC, Camilo C, Simões SN, Martins-Jr DC, Fracolli L, Argeu A, Ferraro A, Matijasevich A, Fatori D, Miguel EC, Polanczyk GV, Brentani H. Maternal immune response during pregnancy and neurodevelopmental outcomes: A longitudinal approach. Brain Behav Immun Health 2024; 40:100832. [PMID: 39193418 PMCID: PMC11347843 DOI: 10.1016/j.bbih.2024.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Background and objectives The neurodevelopment of the offspring is suggested to be influenced by the maternal immune system's responses throughout pregnancy, which in turn is also vulnerable to maternal psychosocial stress conditions. Therefore, our main goal was to investigate whether maternal peripheral immunological biomarkers (IB) during two stages of gestation are associated with distinct neurodevelopmental trajectories in the first two years of life. As a second goal, we also explored the association between maternal distal (childhood) and proximal (gestation) stressful experiences and the immunological markers assessed during pregnancy. Methods Maternal childhood trauma, depressive and anxiety symptoms, and peripheral IB (IFNγ, IL-10, IL1β, IL6, IL8, TNFα, EGF, IL13, IL17, IL1Ra and IL4) were measured at baseline (8-16 weeks of pregnancy) and at 30 weeks of pregnancy in 160 women. The participants had the blood samples collected from two randomized clinical trials conducted by the same team and methods in the same community. A Principal Component Analysis (PCA) was implemented to create meaningful composite variables that describe the cytokines joint variation. Finally, linear mixed-effects modeling was used to investigate the influence of inflammatory biomarkers, maternal childhood trauma, anxiety, and depressive symptoms on Bayley's III scores trajectories. Results The IB profile during the 3rd trimester of pregnancy predicted the offspring's neurodevelopmental trajectories in the first two years of life. The components derived from PCA were important predictors and captured different immune responses, reflecting both pro- and anti-inflammatory states. Maternal stressful experiences did not correlate with the immunological markers. Although not a reliable predictor alone, maternal psychosocial stress at the 1st trimester of pregnancy interacted with the mother's immune response while predicting the neurodevelopmental scores during the first two years of life. Conclusions Our results underscore the importance of the maternal immune response during pregnancy in shaping the neurodevelopmental trajectory of the offspring. Additionally, we observed that the maternal distress at the early stages of pregnancy has an incremental effect on the neurodevelopmental outcome but depends upon the immune response.
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Affiliation(s)
- Veronica Euclydes
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio I.S. Braga
- Center for Mathematics, Computation and Cognition, Federal University of ABC (UFABC), Santo André, SP, Brazil
| | - Gisele Gouveia
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Caroline Camilo
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - David C. Martins-Jr
- Center for Mathematics, Computation and Cognition, Federal University of ABC (UFABC), Santo André, SP, Brazil
| | - Lislaine Fracolli
- Escola de Enfermagem, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Argeu
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alexandre Ferraro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Fatori
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Euripedes C. Miguel
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Guilherme V. Polanczyk
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helena Brentani
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Vutskits L. Developmental anaesthesia neurotoxicity in humans: finding the sweet spot? Br J Anaesth 2024; 132:835-836. [PMID: 38570301 DOI: 10.1016/j.bja.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
A recent human epidemiological study in this issue of British Journal of Anaesthesia examined the association between anaesthesia exposure in pregnant women undergoing appendicectomy or cholecystectomy and the subsequent diagnosis of behavioural disorders in their offspring. When compared with unexposed children, prenatally exposed children had ∼30% greater likelihood of a diagnosis of disruptive or internalising behavioural disorders. Although these data are new and interesting, they should be interpreted with caution. Indeed, appendicitis and cholecystitis can produce acute and chronic systemic inflammation, and maternal immune activation can affect fetal neurodevelopment through inflammatory and epigenetic mechanisms. It is, therefore, possible that the findings are related to maternal and fetal inflammation than to anaesthesia exposure. As there is no causal evidence for the implication that anaesthesia and surgery induce such pathologies, it is unwise to consider alternative treatments when surgery is indicated in pregnant patients.
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Affiliation(s)
- Laszlo Vutskits
- Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland.
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